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BACKGROUND: A comparison of 30-day and 1-year clinical outcomes in patients with pre-existing left ventricular (LV) dysfunction undergoing transcatheter mitral valve edge-to-edge repair (TEER) or transcatheter transapical mitral valve replacement (TMVR) has not previously been reported. AIMS: We aimed to compare 30-day and 1-year rates of all-cause and cardiovascular mortality as well as rehospitalisation for heart failure (HFH). METHODS: All patients with severe (≥3+) symptomatic mitral regurgitation (MR) and an LV ejection fraction ≤50% who underwent TEER or TMVR over a 5-year period were evaluated. RESULTS: Ninety-six patients (50 TEER, age 80±9 years, 70% secondary MR and 46 TMVR, age 72±9 years, 91% secondary MR) were studied. Baseline demographic and transthoracic echocardiogram characteristics were well-matched, with the exception of age (TEER 80±9 vs TMVR 72±9; p=0.01). Successful device implantation occurred in 96% of TEER patients and 97.8% of TMVR patients. Ninety-two percent of TEER patients had ≤2+MR predischarge, whilst no TMVR patient had ≥1+MR (p0.05). At 1 year, freedom from all-cause mortality and HFH was 79.2% across the entire study population but was significantly higher in patients undergoing TEER (TEER: n=45 [90%] hazard ratio 11.26, 95% confidence interval [CI]: 10.59-11.93 vs TMVR: n=39 [67.4%] 95% CI: 10.09-11.33; p=0.008). CONCLUSIONS: Despite comparable rates of successful device implantation, MR reduction, and 30-day all-cause mortality/HFH, TEER patients had lower all-cause mortality and HFH rates at 1 year.

Spontaneous coronary artery dissection (SCAD) is an understudied cause of myocardial infarction primarily affecting women. It is not known to what extent SCAD is genetically distinct from other cardiovascular diseases, including atherosclerotic coronary artery disease (CAD). Here we present a genome-wide association meta-analysis (1,917 cases and 9,292 controls) identifying 16 risk loci for SCAD. Integrative functional annotations prioritized genes that are likely to be regulated in vascular smooth muscle cells and artery fibroblasts and implicated in extracellular matrix biology. One locus containing the tissue factor gene F3, which is involved in blood coagulation cascade initiation, appears to be specific for SCAD risk. Several associated variants have diametrically opposite associations with CAD, suggesting that shared biological processes contribute to both diseases, but through different mechanisms. We also infer a causal role for high blood pressure in SCAD. Our findings provide novel pathophysiological insights involving arterial integrity and tissue-mediated coagulation in SCAD and set the stage for future specific therapeutics and preventions.

Spontaneous coronary artery dissection (SCAD) is an understudied cause of myocardial infarction primarily affecting women. It is not known to what extent SCAD is genetically distinct from other cardiovascular diseases, including atherosclerotic coronary artery disease (CAD). Here we present a genome-wide association meta-analysis (1,917 cases and 9,292 controls) identifying 16 risk loci for SCAD. Integrative functional annotations prioritized genes that are likely to be regulated in vascular smooth muscle cells and artery fibroblasts and implicated in extracellular matrix biology. One locus containing the tissue factor gene F3, which is involved in blood coagulation cascade initiation, appears to be specific for SCAD risk. Several associated variants have diametrically opposite associations with CAD, suggesting that shared biological processes contribute to both diseases, but through different mechanisms. We also infer a causal role for high blood pressure in SCAD. Our findings provide novel pathophysiological insights involving arterial integrity and tissue-mediated coagulation in SCAD and set the stage for future specific therapeutics and preventions.

Control and understanding of ensembles of skyrmions is important for realization of future technologies. In particular, the order-disorder transition associated with the 2D lattice of magnetic skyrmions can have significant implications for transport and other dynamic functionalities. To date, skyrmion ensembles have been primarily studied in bulk crystals, or as isolated skyrmions in thin film devices. Here, we investigate the condensation of the skyrmion phase at room temperature and zero field in a polar, van der Waals magnet. We demonstrate that we can engineer an ordered skyrmion crystal through structural confinement on the μm scale, showing control over this order-disorder transition on scales relevant for device applications.

Surface strain plays a key role in enhancing the activity of Pt-alloy nanoparticle oxygen reduction catalysts. However, the details of strain effects in real fuel cell catalysts are not well-understood, in part due to a lack of strain characterization techniques that are suitable for complex supported nanoparticle catalysts. This work investigates these effects using strain mapping with nanobeam electron diffraction and a continuum elastic model of strain in simple core-shell particles. We find that surface strain is relaxed both by lattice defects at the core-shell interface and by relaxation across particle shells caused by Poisson expansion in the spherical geometry. The continuum elastic model finds that in the absence of lattice dislocations, geometric relaxation results in a surface strain that scales with the average composition of the particle, regardless of the shell thickness. We investigate the impact of these strain effects on catalytic activity for a series of Pt-Co catalysts treated to vary their shell thickness and core-shell lattice mismatch. For catalysts with the thinnest shells, the activity is consistent with an Arrhenius dependence on the surface strain expected for coherent strain in dislocation-free particles, while catalysts with thicker shells showed greater activity losses indicating strain relaxation caused by dislocations as well., 23 pages,7 figures, includes appendix

Background: Renal cell carcinoma (RCC) is twice as common among men compared with women, and hormonal factors have been suggested to partially explain this difference. There is currently little evidence on the roles of reproductive and hormonal risk factors in RCC aetiology. Materials & Methods: We investigated associations of age at menarche and age at menopause, pregnancy-related factors, hysterectomy and ovariectomy and exogenous hormone use with RCC risk among 298,042 women in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Results: During 15 years of follow-up, 438 RCC cases were identified. Parous women had higher rates of RCC compared with nulliparous women (HR = 1.71, 95% CI 1.18, 2.46), and women who were older at age of first pregnancy had lower rates of RCC (30 years + vs.

Using low-temperature cathodoluminescence spectroscopy, we study the properties of N- and Al-polar AlN layers grown by molecular beam epitaxy on bulk AlN{0001}. Compared to the bulk AlN substrate, layers of both polarities feature a suppression of deep-level luminescence, a total absence of the prevalent donor with an exciton binding energy of 28 meV, and a much increased intensity of the emission from free excitons. The dominant donor in these layers is characterized by an associated exciton binding energy of 13 meV. The observation of excited exciton states up to the exciton continuum allows us to directly extract the $\Gamma_{5}$ free exciton binding energy of 57 meV.

Intermetallic Nb3Sn alloys have long been believed to form through Sn diffusion into Nb. However, our observations of significant oxygen content in Nb3Sn prompted an investigation of alternative formation mechanisms. Through experiments involving different oxide interfaces (clean HF-treated, native oxidized, and anodized), we demonstrate a thermodynamic route that fundamentally challenges the conventional Sn diffusion mechanism for Nb3Sn nucleation. Our results highlight the critical involvement of a SnOx intermediate phase. This new nucleation mechanism identifies the principles for growth optimization and new synthesis of high-quality Nb3Sn superconductors.

Surface structures on radio-frequency (RF) superconductors are crucially important in determining their interaction with the RF field. Here we investigate the surface compositions, structural profiles, and valence distributions of oxides, carbides, and impurities on niobium (Nb) and Nb3Sn in situ under different processing conditions. We establish the underlying mechanisms of vacuum baking and nitrogen-processing in Nb and demonstrate that carbide formation induced during high-temperature baking, regardless of gas environment, determines subsequent oxide formation upon air exposure or low-temperature baking, leading to modifications of the electron population profile. Also, we observe that vapor-diffused Nb3Sn contains thick metastable oxides, while electrochemically synthesized Nb3Sn only has a thin oxide layer. Our findings reveal fundamental mechanisms of baking and processing Nb and Nb3Sn surface structures for high-performance superconducting RF and quantum applications.

The nature of superconductivity and its interplay with strong spin-orbit coupling at the KTaO3(111) interfaces remains a subject of debate. To address this problem, we grew epitaxial LaMnO3/KTaO3(111) heterostructures. We show that superconductivity is robust against the in-plane magnetic field, with the critical field of superconductivity reaching 25 T in optimally doped heterostructures. The superconducting order parameter is highly sensitive to carrier density. We argue that spin-orbit coupling drives the formation of anomalous quasiparticles with vanishing magnetic moment, providing the condensate significant immunity against magnetic fields beyond the Pauli paramagnetic limit. These results offer design opportunities for superconductors with extreme resilience against magnetic field.

Superconducting radio-frequency (SRF) resonators are critical components for particle accelerator applications and emerging quantum computers. A promising SRF material is thin-film Nb3Sn with high-quality-factor, high-field, high-operation-temperature potentials. However, surface roughness, non-stoichiometry, and impurities in Nb3Sn deposited by conventional Sn-vapor diffusion prevent their performance from reaching theoretical capabilities. Here we design the deposition process involving seed-free electrochemical synthesis and push the limit of chemical and physical properties in Nb3Sn. Utilization of electrochemical Sn pre-deposits reduces the roughness of converted Nb3Sn by five times compared to typical vapor-diffused Nb3Sn. Quantitative mappings using chemical and atomic probes confirm improved stoichiometry and minimized impurity concentrations in electrochemical Nb3Sn. We have successfully applied this Nb3Sn to the large-scale 1.3 GHz SRF cavity and demonstrated ultra-low BCS surface resistances at multiple operation temperatures, notably lower than vapor-diffused cavities. Our smooth, homogeneous, high-purity Nb3Sn provides the route toward high efficiency and high fields for SRF use.

Background: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone. Methods: The CHOICE-MI registry included patients with MR undergoing TMVR using dedicated devices. Patients with MR etiologies other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial. We compared outcomes between the TMVR and GDMT groups, using propensity score (PS)-matching to adjust for baseline differences. Results: After PS-matching, 97 patient pairs undergoing TMVR (72.9±8.7 years, 60.8% male, transapical access 91.8%) versus GDMT (73.1±11.0 years, 59.8% male) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared to 6.9% and 7.7%, respectively, in those receiving GDMT alone (both p Conclusions: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for HF and similar mortality compared with GDMT.

Magnetic van der Waals heterostructures provide a unique platform to study magnetism and spintronics device concepts in the two-dimensional limit. Here, we report studies of exchange bias from the van der Waals antiferromagnet CrSBr acting on the van der Waals ferromagnet Fe3GeTe2 (FGT). The orientation of the exchange bias is along the in-plane easy axis of CrSBr, perpendicular to the out-of-plane anisotropy of the FGT, inducing a strongly tilted magnetic configuration in the FGT. Furthermore, the in-plane exchange bias provides sufficient symmetry breaking to allow deterministic spin-orbit torque switching of the FGT in CrSBr/FGT/Pt samples at zero applied magnetic field. A minimum thickness of the CrSBr greater than 10 nm is needed to provide a non-zero exchange bias at 30 K.

Superconducting radio-frequency (SRF) resonators are critical components for particle accelerator applications, such as free-electron lasers, and for emerging technologies in quantum computing. Developing advanced materials and their deposition processes to produce RF superconductors that yield nanoohms surface resistances is a key metric for the wider adoption of SRF technology. Here we report ZrNb(CO) RF superconducting films with high critical temperatures (Tc) achieved for the first time under ambient pressure. The attainment of a Tc near the theoretical limit for this material without applied pressure is promising for its use in practical applications. A range of Tc, likely arising from Zr doping variation, may allow a tunable superconducting coherence length that lowers the sensitivity to material defects when an ultra-low surface resistance is required. Our ZrNb(CO) films are synthesized using a low-temperature (100 - 200 C) electrochemical recipe combined with thermal annealing. The phase transformation as a function of annealing temperature and time is optimized by the evaporated Zr-Nb diffusion couples. Through phase control, we avoid hexagonal Zr phases that are equilibrium-stable but degrade Tc. X-ray and electron diffraction combined with photoelectron spectroscopy reveal a system containing cubic ZrNb mixed with rocksalt NbC and low-dielectric-loss ZrO2. We demonstrate proof-of-concept RF performance of ZrNb(CO) on an SRF sample test system. BCS resistance trends lower than reference Nb, while quench fields occur at approximately 35 mT. Our results demonstrate the potential of ZrNb(CO) thin films for particle accelerator and other SRF applications.

AIMS Transcatheter mitral valve implantation (TMVI) represents a novel treatment option for patients with mitral regurgitation (MR) unsuitable for established therapies. The CHOICE-MI registry aimed to investigate outcomes of patients undergoing screening for TMVI. METHODS AND RESULTS From 05/2014 to 03/2021, patients with MR considered suboptimal candidates for transcatheter edge-to-edge repair (TEER) and at high risk for mitral valve surgery underwent TMVI screening at 26 centres. Characteristics and outcomes were investigated for patients undergoing TMVI and for TMVI-ineligible patients referred to bailout-TEER, high-risk surgery or medical therapy (MT). The primary composite endpoint was all-cause mortality or heart failure hospitalisation after 1 year. Among 746 patients included (78.5 years [IQR 72.0-83.0], EuroSCORE II 4.7% [IQR 2.7-9.7]), 229 patients (30.7%) underwent TMVI with ten different dedicated devices. At 1 year, residual MR ≤1+ was present in 95.2% and the primary endpoint occurred in 39.2% of patients treated with TMVI. In TMVI-ineligible patients (N = 517, 69.3%), rates of residual MR ≤1+ were 37.2%, 100.0% and 2.4% after bailout-TEER, high-risk surgery and MT, respectively. The primary endpoint at 1 year occurred in 28.8% of patients referred to bailout-TEER, in 42.9% of patients undergoing high-risk surgery and in 47.9% of patients remaining on MT. CONCLUSION This registry included the largest number of patients treated with TMVI to date. TMVI with ten dedicated devices resulted in predictable MR elimination and sustained functional improvement at 1 year. In TMVI-ineligible patients, bailout-TEER and high-risk surgery represented reasonable alternatives, while MT was associated with poor clinical and functional outcomes. This article is protected by copyright. All rights reserved.

Adiposity is implicated in the development of advanced prostate cancer but its association with prostate prognosis remains inconclusive. It is important to clarify the associations between adiposity and prostate prognosis to then enable the design of currently limited evidence-based weight-management interventions tailored to prostate cancer patients.

Niobium-zirconium (Nb-Zr) alloy is an old superconductor that is a promising new candidate for superconducting radio-frequency (SRF) cavity applications. Using density-functional and Eliashberg theories, we show that addition of Zr to a Nb surface in small concentrations increases the critical temperature $T_c$ and improves other superconducting properties. Furthermore, we calculate $T_c$ for Nb-Zr alloys across a broad range of Zr concentrations, showing good agreement with the literature for disordered alloys as well as the potential for significantly higher $T_c$ in ordered alloys near 75%Nb/25%Zr composition. We provide experimental verification on Nb-Zr alloy samples and SRF sample test cavities prepared with either physical vapor or our novel electrochemical deposition recipes. These samples have the highest measured $T_c$ of any Nb-Zr superconductor to date and indicate a reduction in BCS resistance compared to the conventional Nb reference sample; they represent the first steps along a new pathway to greatly enhanced SRF performance. Finally, we use Ginzburg-Landau theory to show that the addition of Zr to a Nb surface increases the superheating field $B_{sh}$, a key figure of merit for SRF which determines the maximum accelerating gradient at which cavities can operate., 7 pages, 5 figures, submitted to Physical Review Letters

Background: The relation between blood pressure and kidney cancer risk is well established but complex and different study designs have reported discrepant findings on the relative importance of diastolic blood pressure (DBP) and systolic blood pressure (SBP). In this study, we sought to describe the temporal relation between diastolic and SBP with renal cell carcinoma (RCC) risk in detail. Methods: Our study involved two prospective cohorts: the European Prospective Investigation into Cancer and Nutrition study and UK Biobank, including >700 000 participants and 1692 incident RCC cases. Risk analyses were conducted using flexible parametric survival models for DBP and SBP both separately as well as with mutuality adjustment and then adjustment for extended risk factors. We also carried out univariable and multivariable Mendelian randomization (MR) analyses (DBP: ninstruments = 251, SBP: ninstruments = 213) to complement the analyses of measured DBP and SBP. Results: In the univariable analysis, we observed clear positive associations with RCC risk for both diastolic and SBP when measured ≥5 years before diagnosis and suggestive evidence for a stronger risk association in the year leading up to diagnosis. In mutually adjusted analysis, the long-term risk association of DBP remained, with a hazard ratio (HR) per standard deviation increment 10 years before diagnosis (HR10y) of 1.20 (95% CI: 1.10-1.30), whereas the association of SBP was attenuated (HR10y: 1.00, 95% CI: 0.91-1.10). In the complementary multivariable MR analysis, we observed an odds ratio for a 1-SD increment (ORsd) of 1.34 (95% CI: 1.08-1.67) for genetically predicted DBP and 0.70 (95% CI: 0.56-0.88) for genetically predicted SBP. Conclusion: The results of this observational and MR study are consistent with an important role of DBP in RCC aetiology. The relation between SBP and RCC risk was less clear but does not appear to be independent of DBP. © 2022 World Health Organization,. All rights reserved. The World Health Organization has granted the Publisher permission for the reproduction of this article.

Sexual dimorphism in cancer incidence and outcome is widespread. Understanding the underlying mechanisms is fundamental to improve cancer prevention and clinical management. Sex disparities are particularly striking in kidney cancer: across diverse populations, men consistently show unexplained 2-fold increased incidence and worse prognosis. We have characterized genome-wide expression and regulatory networks of 609 renal tumors and 256 non-tumor renal tissues. Normal kidney displayed sex-specific transcriptional signatures, including higher expression of X-linked tumor suppressor genes in women. Sex-dependent genotype–phenotype associations unraveled women-specific immune regulation. Sex differences were markedly expanded in tumors, with male-biased expression of key genes implicated in metabolism, non-malignant diseases with male predominance and carcinogenesis, including markers of tumor infiltrating leukocytes. Analysis of sex-dependent RCC progression and survival uncovered prognostic markers involved in immune response and oxygen homeostasis. In summary, human kidney tissues display remarkable sexual dimorphism at the molecular level. Sex-specific transcriptional signatures further shape renal cancer, with relevance for clinical management.

Novel magnetic ground states have been stabilized in two-dimensional (2D) magnets such as skyrmions, with the potential next-generation information technology. Here, we report the experimental observation of a Néel-type skyrmion lattice at room temperature in a single-phase, layered 2D magnet, specifically a 50% Co-doped Fe5GeTe2 (FCGT) system. The thickness-dependent magnetic domain size follows Kittel's law. The static spin textures and spin dynamics in FCGT nanoflakes were studied by Lorentz electron microscopy, variable-temperature magnetic force microscopy, micromagnetic simulations, and magnetotransport measurements. Current-induced skyrmion lattice motion was observed at room temperature, with a threshold current density, jth = 1 × 106 A/cm2. This discovery of a skyrmion lattice at room temperature in a noncentrosymmetric material opens the way for layered device applications and provides an ideal platform for studies of topological and quantum effects in 2D.

This is the data accompanying the manuscript tilted "Tilted spin current generated by the collinear antiferromagnet ruthenium oxide" which has been accepted for publication in Nature Electronics.

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In condensed-matter systems, competition between ground states at phase boundaries can lead to significant changes in material properties under external stimuli, particularly when these ground states have different crystal symmetries. A key scientific and technological challenge is to stabilize and control coexistence of symmetry-distinct phases with external stimuli. Using BiFeO3 (BFO) layers confined between layers of the dielectric TbScO3 as a model system, we stabilize the mixed-phase coexistence of centrosymmetric and non-centrosymmetric BFO phases with antipolar, insulating and polar, semiconducting behavior, respectively at room temperature. Application of in-plane electric (polar) fields can both remove and introduce centrosymmetry from the system resulting in reversible, nonvolatile interconversion between the two phases. This interconversion between the centrosymmetric insulating and non-centrosymmetric semiconducting phases coincides with simultaneous changes in the non-linear optical response of over three orders of magnitude, a change in resistivity of over five orders of magnitude, and a change in the polar order. Our work establishes a materials platform allowing for novel cross-functional devices which take advantage of changes in optical, electrical, and ferroic responses., Comment: L Caretta and Y-T Shao contributed equally. 64 pages, 4 figures, 25 supplemental figures, 1 supplemental table

Additional file 1: Circulating inflammatory biomarkers and breast cancer risk in the EPIC prospective study: Supplementary Tables S1- S7 and Figures S1-S3. Table S1. Geometric mean values for inflammatory biomarkers in breast cancer cases and matched controls. Table S2. Associations between inflammatory biomarkers and breast cancer risk by age at diagnosis. Table S3. Associations between inflammatory biomarkers and breast cancer risk by breast cancer molecular subtypes. Table S4. Associations between inflammatory biomarkers and breast cancer risk by time between blood collection and diagnosis. Table S5. Associations between inflammatory biomarkers and breast cancer risk by body mass index. Table S6. Associations between inflammatory biomarkers and breast cancer risk by waist circumference. Table S7. Associations between inflammatory biomarkers and breast cancer risk among non-hormone users at blood collection. Table S8. Associations between IL-10 and breast cancer risk overall and according to menopausal status at blood collection, after excluding women with values of IL-10 below the LOQ. Table S9. Associations between TNF-α and breast cancer risk overall and according to menopausal status at blood collection, after excluding women with values of TNF-α below the LOQ. Figure S1. Flow chart of the study population. Figure S2. Association between leptin and breast cancer risk, overall and by menopausal status, allowing for nonlinear effects (restricted cubic spline). Figure S3. Association between leptin-to-adiponectin ratio and breast cancer risk, overall and by menopausal status, allowing for nonlinear effects (restricted cubic spline). Figure S4. Association between CRP with breast cancer risk, overall and by menopausal status, allowing for nonlinear effects (restricted cubic spline).

We complete measurements of interconversions among the full triad of thermal gradients, charge currents, and spin currents in the topological insulator Bi$_2$Se$_3$ by quantifying the efficiency with which thermal gradients can generate transverse spin currents. We accomplish this by comparing the spin Nernst magneto-thermopower to the spin Hall magnesistance for bilayers of Bi$_2$Se$_3$/CoFeB. We find that Bi$_2$Se$_3$ does generate substantial thermally-driven spin currents. A lower bound for the ratio of spin current to thermal gradient is $J_s/\nabla_x T$ = (4.9 $\pm$ 0.9) $\times$ 10$^{6}$ ($\hbar/2e$) A m$^{-2}$ / K $\mu$m$^{-1}$, and a lower bound for the magnitude of the spin Nernst ratio is $-$0.61 $\pm$ 0.11. The spin Nernst ratio for Bi$_2$Se$_3$ is the largest among all materials measured to date, 2-3 times larger compared to previous measurements for the heavy metals Pt and W.

Background: The relation between blood pressure and kidney cancer risk is well established but complex and different study designs have reported discrepant findings on the relative importance of diastolic blood pressure (DBP) and systolic blood pressure (SBP). In this study, we sought to describe the temporal relation between diastolic and SBP with renal cell carcinoma (RCC) risk in detail. Methods: Our study involved two prospective cohorts: the European Prospective Investigation into Cancer and Nutrition study and UK Biobank, including >700 000 participants and 1692 incident RCC cases. Risk analyses were conducted using flexible parametric survival models for DBP and SBP both separately as well as with mutuality adjustment and then adjustment for extended risk factors. We also carried out univariable and multivariable Mendelian randomization (MR) analyses (DBP: ninstruments = 251, SBP: ninstruments = 213) to complement the analyses of measured DBP and SBP. Results: In the univariable analysis, we observed clear positive associations with RCC risk for both diastolic and SBP when measured ≥5 years before diagnosis and suggestive evidence for a stronger risk association in the year leading up to diagnosis. In mutually adjusted analysis, the long-term risk association of DBP remained, with a hazard ratio (HR) per standard deviation increment 10 years before diagnosis (HR10y) of 1.20 (95% CI: 1.10-1.30), whereas the association of SBP was attenuated (HR10y: 1.00, 95% CI: 0.91-1.10). In the complementary multivariable MR analysis, we observed an odds ratio for a 1-SD increment (ORsd) of 1.34 (95% CI: 1.08-1.67) for genetically predicted DBP and 0.70 (95% CI: 0.56-0.88) for genetically predicted SBP. Conclusion: The results of this observational and MR study are consistent with an important role of DBP in RCC aetiology. The relation between SBP and RCC risk was less clear but does not appear to be independent of DBP. © 2022 World Health Organization,. All rights reserved. The World Health Organization has granted the Publisher permission for the reproduction of this article.

Additional file 1. Supplementary material regarding (i) the definition of cancer cases for HCC, GBC, Adv.PrC and Loc.PrC; (ii) the definition and implementation of the data-shared lasso; (iii) the models used to derive point estimates and confidence intervals from the model selected by the data-shared lasso; and (iv) the univariate analysis conducted for comparison.

Additional file 2: Supplementary tables and figures. Figure S1. Pearson correlation between the 117 original metabolites. Figure S2. Sensitivity analyses of mutually adjusted ORs for the overall associations and cancer type-specific deviations. Figure S3. Sensitivity analysis of mutually adjusted ORs for the overall associations and cancer type-specific deviations with or without excluding hormone users. Figure S4. p-values of tests for departure from linearity and effect modification by BMI. Figure S5. ORs for the overall associations identified by the data-shared lasso with (i) the original model (ii) the extended type-specific model. Figure S6. Results from the univariate analyses. Figure S7. Comparison of the associations identified by the data-shared lasso when working with the 50 features (as in our main analysis) or with the original 117 metabolites. Figure S8. Pearson correlation between the 50 clusters. Figure S9. Pearson correlation between the 19 features related to at least one cancer site in our main analysis. Table S1. list of the 117 metabolites studied in the main analysis, and of the 16 additional metabolites studied when excluding the second colorectal study. Table S2. Robustness of the associations identified in the main analysis when including all the pairs from the prostate cancer study. Table S3. Other associations identified in a large proportion of bootstrap samples when including all the pairs from the prostate cancer study.

The properties of niobium oxide are of critical importance for a wide range of topics, from the behavior of nitrogen during infusion treatments, to the nucleation of Nb₃Sn, to the superconducting properties of the surface. However, the modeling of the oxide is often much simplified, ignoring the variety of niobium oxide phases and the extremely different properties of these phases in the presence of impurities and defects. We use density functional theory (DFT) to investigate how electrochemical treatments and gas infusion procedures change the properties of niobium oxide, and to investigate how these properties could be optimized for Nb₃Sn nucleation and for niobium SRF performance., Proceedings of the 20th International Conference on RF Superconductivity, SRF2021, East Lansing, MI, USA

Reducing surface roughness and attaining stoichiometry of Nb₃Sn superconducting films are required to push their superheating field to the theoretical limit in SRF cavities. As such, we explore direct electrochemical processes that minimize involving foreign elements to deposit high-quality Sn, Nb, and NbxSn films on Nb and Cu surfaces. These films are then thermally annealed to Nb₃Sn. We find that smooth Sn pre-depositions via electroplating on Nb surfaces significantly reduce the average roughness of resultant Nb₃Sn to 65 nm, with a dramatic reduction in power intensity at medium special frequencies. Structural and superconducting properties demonstrate a Nb₃Sn A15 phase with a stoichiometry of 25 at% Sn. This process is being scaled-up to a 3.9 GHz cavity. Moreover, preliminary results on electroplating on Cu surface show that Nb plating undergoes a slow growth rate while subsequent Sn plating on the plated Nb surface can be controlled with varied thickness. The Nb plating process is currently being optimized., Proceedings of the 20th International Conference on RF Superconductivity, SRF2021, East Lansing, MI, USA

Surface oxides on Nb and Nb₃Sn SRF cavities, as a thin ’dirty’ layer, could be critical to their performance as suggested by recent theory. Although these oxides have been studied in the past, we intend here to provide a deeper understanding based on a systematic study on coupon samples that have been processed under the different conditions currently used in SRF cavity treatments. Our aim is to obtain a more complete picture of the oxide evolution. This then might help to explain the observed cavity performance variation, and might allow designing a process to achieve a designed, optimized surface with controlled oxides types and thickness. We find that the surface oxides are in amorphous phase that exhibits normal conducting behaviors, while the pentoxide further degrades with time. Also, we observed a thin hydroxide layer on the outermost surface and possibly Nb(OH)x motifs in the bulk. Moreover, distinctive oxide structures were found in Nb₃Sn samples from vapor diffusion, electroplating, and sputtering. The semiconducting SnOx appeared through the oxide depth in vapor diffused Nb₃Sn, while a ~1 nm SnOx layer merely exists at the outermost surface of electroplated Nb₃Sn., Proceedings of the 20th International Conference on RF Superconductivity, SRF2021, East Lansing, MI, USA

We observe a catalytic mechanism during the growth of III-O and IV-O materials by suboxide molecular-beam epitaxy ($S$-MBE). By supplying the molecular catalysts In$_2$O and SnO we increase the growth rates of Ga$_2$O$_3$ and In$_2$O$_3$. This catalytic action is explained by a metastable adlayer $A$, which increases the reaction probability of the reactants Ga$_2$O and In$_2$O with active atomic oxygen, leading to an increase of the growth rates of Ga$_2$O$_3$ and In$_2$O$_3$. We derive a model for the growth of binary III-O and IV-O materials by $S$-MBE and apply these findings to a generalized catalytic description for metal-oxide catalyzed epitaxy (MOCATAXY), applicable to elemental and molecular catalysts. We derive a mathematical description of $S$-MBE and MOCATAXY providing a computational framework to set growth parameters in previously inaccessible kinetic and thermodynamic growth regimes when using the aforementioned catalysis. Our results indicate MOCATAXY takes place with a suboxide catalyst rather than with an elemental catalyst. As a result of the growth regimes achieved, we demonstrate a Ga$_2$O$_3$/Al$_2$O$_3$ heterostructure with unrivaled crystalline quality, paving the way to the preparation of oxide device structures with unprecedented perfection.

The advent of long-range magnetic order in non-centrosymmetric compounds has stimulated interest in the possibility of exotic spin transport phenomena and topologically protected spin textures for applications in next-generation spintronics. This work reports a novel wurtzite-structure polar magnetic metal, identified as AA'-stacked (Fe0.5Co0.5)5-xGeTe2, which exhibits a Neel-type skyrmion lattice as well as a Rashba-Edelstein effect at room temperature. Atomic resolution imaging of the structure reveals a structural transition as a function of Co-substitution, leading to the polar phase at 50% Co. This discovery reveals an unprecedented layered polar magnetic system for investigating intriguing spin topologies and ushers in a promising new framework for spintronics.

Room temperature ferroelectricity is observed in lattice-matched ~18% ScAlN/GaN heterostructures grown by molecular beam epitaxy on single-crystal GaN substrates. The epitaxial films have smooth surface morphologies and high crystallinity. Pulsed current-voltage measurements confirm stable and repeatable polarization switching in such ferroelectric/semiconductor structures at several measurement conditions, and in multiple samples. The measured coercive field values are Ec~0.7 MV/cm at room temperature, with remnant polarization Pr~10 {\mu}C/cm2 for ~100 nm thick ScAlN layers. These values are substantially lower than comparable ScAlN control layers deposited by sputtering. Importantly, the coercive field of MBE ScAlN is smaller than the critical breakdown field of GaN, offering the potential for low voltage ferroelectric switching. The low coercive field ferroelectricity of ScAlN on GaN heralds the possibility of new forms of electronic and photonic devices with epitaxially integrated ferroelectric/semiconductor heterostructures that take advantage of the GaN electronic and photonic semiconductor platform, where the underlying semiconductors themselves exhibit spontaneous and piezoelectric polarization.

Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity. We compared the ability of alternative waist indices to complement body mass index (BMI) when assessing all-cause mortality. We used data from 352,985 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) and Cox proportional hazards models adjusted for other risk factors. During a mean follow-up of 16.1 years, 38,178 participants died. Combining in one model BMI and a strongly correlated waist index altered the association patterns with mortality, to a predominantly negative association for BMI and a stronger positive association for the waist index, while combining BMI with the uncorrelated A Body Shape Index (ABSI) preserved the association patterns. Sex-specific cohort-wide quartiles of waist indices correlated with BMI could not separate high-risk from low-risk individuals within underweight (BMI, Zweitver��ffentlichungen der Universit��t Potsdam : Mathematisch-Naturwissenschaftliche Reihe; 1200

We report measurements demonstrating that when the Neel vector of the collinear antiferromagnet RuO2 is appropriately canted relative to the sample plane, the antiferromagnet generates a substantial out of plane damping-like torque. The measurements are in good accord with predictions that when an electric field, E is applied to the spin split band structure of RuO2 it can cause a strong transverse spin current even in the absence of spin-orbit coupling. This produces characteristic changes in all three components of the E induced torque vector as a function of the angle of E relative to the crystal axes, corresponding to a spin current with a well defined tilted spin orientation s approximately (but not exactly) parallel to the Neel vector, flowing perpendicular to both E and S. This angular dependence is the signature of an antiferromagnetic spin Hall effect with symmetries that are distinct from other mechanisms of spin-current generation reported in antiferromagnetic or ferromagnetic materials.

International audience; Background: Spontaneous coronary artery dissection (SCAD) occurs when an epicardial coronary artery is narrowed or occluded by an intramural hematoma. SCAD mainly affects women and is associated with pregnancy and systemic arteriopathies, particularly fibromuscular dysplasia. Variants in several genes, such as those causing connective tissue disorders, have been implicated; however, the genetic architecture is poorly understood. Here, we aim to better understand the diagnostic yield of rare variant genetic testing among a cohort of SCAD survivors and to identify genes or gene sets that have a significant enrichment of rare variants. Methods: We sequenced a cohort of 384 SCAD survivors from the United Kingdom, alongside 13 722 UK Biobank controls and a validation cohort of 92 SCAD survivors. We performed a research diagnostic screen for pathogenic variants and exome-wide and gene-set rare variant collapsing analyses. Results: The majority of patients within both cohorts are female, 29% of the study cohort and 14% validation cohort have a remote arteriopathy. Four cases across the 2 cohorts had a diagnosed connective tissue disorder. We identified pathogenic or likely pathogenic variants in 7 genes ( PKD1 , COL3A1 , SMAD3 , TGFB2 , LOX , MYLK , and YY1AP1 ) in 14/384 cases in the study cohort and in 1/92 cases in the validation cohort. In our rare variant collapsing analysis, PKD1 was the highest-ranked gene, and several functionally plausible genes were enriched for rare variants, although no gene achieved study-wide statistical significance. Gene-set enrichment analysis suggested a role for additional genes involved in renal function. Conclusions: By studying the largest sequenced cohort of SCAD survivors, we demonstrate that, based on current knowledge, only a small proportion have a pathogenic variant that could explain their disease. Our findings strengthen the overlap between SCAD and renal and connective tissue disorders, and we highlight several new genes for future validation.

$\beta$-Ga$_2$O$_3$ is a promising ultra-wide bandgap semiconductor whose properties can be further enhanced by alloying with Al. Here, using atomic-resolution scanning transmission electron microscopy (STEM), we find the thermodynamically-unstable $\gamma$-phase is a ubiquitous defect in both $\beta$-(Al$_x$Ga$_{1\text{-}x}$)$_2$O$_3$ films and doped $\beta$-Ga$_2$O$_3$ films grown by molecular beam epitaxy. For undoped $\beta$-(Al$_x$Ga$_{1\text{-}x}$)$_2$O$_3$ films we observe $\gamma$-phase inclusions between nucleating islands of the $\beta$-phase at lower growth temperatures (~400-600 $^{\circ}$C). In doped $\beta$-Ga$_2$O$_3$, a thin layer of the $\gamma$-phase is observed on the surfaces of films grown with a wide range of n-type dopants and dopant concentrations. The thickness of the $\gamma$-phase layer was most strongly correlated with the growth temperature, peaking at about 600 $^{\circ}$C. Ga interstitials are observed in $\beta$-phase, especially near the interface with the $\gamma$-phase. By imaging the same region of the surface of a Sn-doped $\beta$-(Al$_x$Ga$_{1\text{-}x}$)$_2$O$_3$ after ex-situ heating up to 400 $^{\circ}$C, a $\gamma$-phase region is observed to grow above the initial surface, accompanied by a decrease in Ga interstitials in the $\beta$-phase. This suggests that the diffusion of Ga interstitials towards the surface is likely the mechanism for growth of the surface $\gamma$-phase, and more generally that the more-open $\gamma$-phase may offer diffusion pathways to be a kinetically-favored and early-forming phase in the growth of Ga$_2$O$_3$.

The achievable instrumental performance of a scanning transmission electron microscope (STEM) is determined by the size and shape of the incident electron probe. The most important optical factor in achieving the optimum probe profile is the radius of the probe-forming aperture, which determines the convergence semi-angle of the illumination. What is often overlooked however is that small deviations from this optimum can degrade both the resolution and interpretability of image contrast. A 30% error in aperture radius can lead to a factor of 2 contrast reduction in typical lattice spacings, and a 5 {\AA} error in the thickness measurement of thin layers (such as gate oxides). Theoretical calculations of the optimum convergence angles, from a wave-optical consideration of the probe forming conditions, are explained and their consequences discussed. An experimental approach to the measurement and tuning of the convergence angle is then introduced. This is intended for uncorrected electron microscopes. For corrected instruments, Cs=0, and Cc usually determines the choice of aperture - see e.g. ULTRAMICROSCOPY 108, (2008) 1454-1466, Comment: 12 pages, 11 figures

Objective: To evaluate the impact of faecal immunochemical testing (FIT) prioritisation to mitigate the impact of delay in the 2-week-wait (2WW) colorectal cancer (CRC) urgent diagnostic pathway consequent from the Coronavirus disease 2019 (COVID-19) pandemic. Design: We modelled the reduction in CRC survival and life years lost resultant from per-patient delays of 2-6 months in the 2WW pathway. We stratified by age-group, individual-level benefit in CRC cancer survival versus age-specific nosocomial COVID-19-related fatality per referred patient undergoing colonoscopy. We modelled mitigation strategies using thresholds of FIT triage of 2, 10 and 150 ug Hb/g to prioritise 2WW referrals for colonoscopy. To construct the underlying models, we employed 10-year net CRC survival for England 2008-2017, 2WW pathway CRC case and referral volumes and per-day-delay hazard ratios generated from observational studies of diagnosis-to-treatment interval. Results: Delay of 2/ 4/ 6 months across all 11,266 CRC patients diagnosed per typical year via the 2WW pathway were estimated to result in 653/ 1,419/ 2,250 attributable deaths and loss of 9,214/ 20,315/ 32,799 life years. Risk-benefit from urgent investigatory referral is particularly sensitive to nosocomial COVID-19 infection rates for patients aged >60. Prioritisation out of delay for the 18% of symptomatic referrals with FIT >10 ug Hb/g would avoid 89% of these deaths attributable to delay, whilst reducing immediate requirement for colonoscopy by >80%. Conclusions: Delays in the pathway to CRC diagnosis and treatment have potential to cause significant mortality and loss of life years. FIT-triage of symptomatic patients in primary care could streamline access to colonoscopy, reduce delays for true-positive CRC cases and reduce nosocomial COVID-19 mortality in older true-negative 2WW referrals. However, this strategy offers benefit only in short-term rationalisation of limited endoscopy services: the appreciable false-negative rate in symptomatic patients of FIT means colonoscopy is still required in the majority.

Ultra-wide bandgap semiconductors are ushering in the next generation of high power electronics. The correct crystal orientation can make or break successful epitaxy of such semiconductors. Here it is discovered that single-crystalline layers of $\alpha$-(AlGa)$_2$O$_3$ alloys spanning bandgaps of 5.4 - 8.6 eV can be grown by molecular beam epitaxy. The key step is found to be the use of m-plane sapphire crystal. The phase transition of the epitaxial layers from the $\alpha$- to the narrower bandgap $\beta$-phase is catalyzed by the c-plane of the crystal. Because the c-plane is orthogonal to the growth front of the m-plane surface of the crystal, the narrower bandgap pathways are eliminated, revealing a route to much wider bandgap materials with structural purity. The resulting energy bandgaps of the epitaxial layers span a range beyond the reach of all other semiconductor families, heralding the successful epitaxial stabilization of the largest bandgap materials family to date., Comment: 22 pages, 8 figures

The observation of extraordinarily high conductivity in delafossite-type PdCoO2 is of great current interest, and there is some evidence that electrons behave like a fluid when flowing in bulk crystals of PdCoO2. Thus, this material is an ideal platform for the study of the electron transfer processes in heterogeneous reactions. Here, we report the use of bulk single crystal PdCoO2 as a promising electrocatalyst for hydrogen evolution reactions (HERs). An overpotential of only 31 mV results in a current density of 10 mA cm^(-2), accompanied by high long-term stability. We have precisely determined that the crystal surface structure is modified after electrochemical activation with the formation of strained Pd nanoclusters in the surface layer. These nanoclusters exhibit reversible hydrogen sorption and desorption, creating more active sites for hydrogen access. The bulk PdCoO2 single crystal with ultra-high conductivity, which acts as a natural substrate for the Pd nanoclusters, provides a high-speed channel for electron transfer

Background: Circulating concentrations of biomarkers that are related to vitamin status vary by factors such as diet, fortification, and supplement use. Published biomarker concentrations have also been influenced by the variation across laboratories, which complicates a comparison of results from different studies. Objective: We robustly and comprehensively assessed differences in biomarkers that are related to vitamin status across geographic regions. Design: The trial was a cross-sectional study in which we investigated 38 biomarkers that are related to vitamin status and one-carbon and tryptophan metabolism in serum and plasma from 5314 healthy control subjects representing 20 cohorts recruited from the United States, Nordic countries, Asia, and Australia, participating in the Lung Cancer Cohort Consortium. All samples were analyzed in a centralized laboratory. Results: Circulating concentrations of riboflavin, pyridoxal 5′-phosphate, folate, vitamin B-12, all-trans retinol, 25-hydroxyvitamin D, and α-tocopherol as well as combined vitamin scores that were based on these nutrients showed that the general B-vitamin concentration was highest in the United States and that the B vitamins and lipid soluble vitamins were low in Asians. Conversely, circulating concentrations of metabolites that are inversely related to B vitamins involved in the one-carbon and kynurenine pathways were high in Asians. The high B-vitamin concentration in the United States appears to be driven mainly by multivitamin-supplement users. Conclusions: The observed differences likely reflect the variation in intake of vitamins and, in particular, the widespread multivitamin-supplement use in the United States. The results provide valuable information about the differences in biomarker concentrations in populations across continents.

Resonant radiofrequency cavities enable exquisite time-energy control of electron beams when synchronized with laser driven photoemission. We present a lossless monochromator design that exploits this fine control in the one-electron-per-pulse regime. The theoretically achievable maximum beam current on target is orders of magnitude greater than state-of-the-art monochromators for the same spatial and energy resolution. This improvement is the result of monochromating in the time domain, unconstrained by the transverse brightness of the electron source. We show analytically and confirm numerically that cavity parameters chosen to minimize energy spread perform the additional function of undoing the appreciable effect of chromatic aberration in the upstream optics. We argue that our design has significant applications in both ultra-fast and non-time-resolved microscopy, provided photoelectron sources of sufficiently small size and laser sources of sufficiently high repetition rate. Our design achieves in simulations more than two orders of magnitude reduction in beam energy spread, down to single digit meV. Overcoming the minimum probe-size limit that chromatic aberration imposes, our design clears a path for high-current, high-resolution electron beam applications at primary energies from single to hundreds of keV.

Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. During a mean follow‐up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric noncardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI ≥30 vs. 18.5–25 kg/m2: HR = 1.94, 95% CI: 1.25–3.03) and women (HR = 2.66, 95% CI: 1.15–6.19); however, adjustment for waist‐to‐hip ratio (WHR) attenuated these associations. After mutual adjustment for BMI and HC, respectively, WHR and waist circumference (WC) were associated with EA in men (HR = 3.47, 95% CI: 1.99–6.06 for WHR >0.96 vs. 98 vs. 0.82 vs. 84 vs. 2 vs. 0) and age at first pregnancy and GNC (HR = 0.54, 95% CI: 0.32–0.91; >26 vs., What's new? Obesity can change the body's hormone balance, and encourage the onset of cancer. Here, the authors investigated the relationship between obesity, hormones, and esophageal and gastric cancers. Using data from the EPIC cohort, they obtained information about anthropometric and reproductive factors for 476,160 participants. Excess fat around the waist, they found, was associated with esophageal adenocarcinoma and gastric cardia cancer, in women and men. In women, bearing children, as well as younger age at first pregnancy, had an inverse association with certain cancers. Ovariectomy was positively associated with gastric non‐cardia cancer, suggesting involvement of hormone pathways in these malignancies.

Transition metal oxides such as vanadium dioxide (VO$_2$), niobium dioxide (NbO$_2$), and titanium sesquioxide (Ti$_2$O$_3$) are known to undergo a temperature-dependent metal-insulator transition (MIT) in conjunction with a structural transition within their bulk. However, it is not typically discussed how breaking crystal symmetry via surface termination affects the complicated MIT physics. Using synchrotron-based x-ray spectroscopy, low energy electron diffraction (LEED), low energy electron microscopy (LEEM), transmission electron microscopy (TEM), and several other experimental techniques, we show that suppression of the bulk structural transition is a common feature at VO$_2$ surfaces. Our density functional theory (DFT) calculations further suggest that this is due to inherent reconstructions necessary to stabilize the surface, which deviate the electronic structure away from the bulk d$^1$ configuration. Our findings have broader ramifications not only for the characterization of other "Mott-like" MITs, but also for any potential device applications of such materials.

Ultra-wide bandgap semiconductors are ushering in the next generation of high power electronics. The correct crystal orientation can make or break successful epitaxy of such semiconductors. Here it is discovered that single-crystalline layers of $��$-(AlGa)$_2$O$_3$ alloys spanning bandgaps of 5.4 - 8.6 eV can be grown by molecular beam epitaxy. The key step is found to be the use of m-plane sapphire crystal. The phase transition of the epitaxial layers from the $��$- to the narrower bandgap $��$-phase is catalyzed by the c-plane of the crystal. Because the c-plane is orthogonal to the growth front of the m-plane surface of the crystal, the narrower bandgap pathways are eliminated, revealing a route to much wider bandgap materials with structural purity. The resulting energy bandgaps of the epitaxial layers span a range beyond the reach of all other semiconductor families, heralding the successful epitaxial stabilization of the largest bandgap materials family to date., 22 pages, 8 figures

The study of nanoscale chiral magnetic order in polycrystalline materials with a strong Dzyaloshinkii-Moriya interaction (DMI) is interesting for the observation of magnetic phenomena at grain boundaries and interfaces. One such material is sputter-deposited B20 FeGe on Si, which has been actively investigated as the basis for low-power, high-density magnetic memory technology in a scalable material platform. Although conventional Lorentz electron microscopy provides the requisite spatial resolution to probe chiral magnetic textures in single-crystal FeGe, probing the magnetism of sputtered B20 FeGe is more challenging because the sub-micron crystal grains add confounding contrast. We address the challenge of disentangling magnetic and grain contrast by applying 4-dimensional Lorentz scanning transmission electron microscopy using an electron microscope pixel array detector. Supported by analytical and numerical models, we find that the most important parameter for imaging magnetic materials with polycrystalline grains is the ability for the detector to sustain large electron doses, where having a high-dynamic range detector becomes extremely important. Despite the small grain size in sputtered B20 FeGe on Si, using this approach we are still able to observe helicity switching of skyrmions and magnetic helices across two adjacent grains as they thread through neighboring grains. We reproduce this effect using micromagnetic simulations by assuming that the grains have distinct orientation and magnetic chirality and find that magnetic helicity couples to crystal chirality. Our methodology for imaging magnetic textures is applicable to other thin-film magnets used for spintronics and memory applications, where an understanding of how magnetic order is accommodated in polycrystalline materials is important., Comment: 22 pages, 8 figures, 2 appendix figures

$��$-Ga$_2$O$_3$ is a promising ultra-wide bandgap semiconductor whose properties can be further enhanced by alloying with Al. Here, using atomic-resolution scanning transmission electron microscopy (STEM), we find the thermodynamically-unstable $��$-phase is a ubiquitous defect in both $��$-(Al$_x$Ga$_{1\text{-}x}$)$_2$O$_3$ films and doped $��$-Ga$_2$O$_3$ films grown by molecular beam epitaxy. For undoped $��$-(Al$_x$Ga$_{1\text{-}x}$)$_2$O$_3$ films we observe $��$-phase inclusions between nucleating islands of the $��$-phase at lower growth temperatures (~400-600 $^{\circ}$C). In doped $��$-Ga$_2$O$_3$, a thin layer of the $��$-phase is observed on the surfaces of films grown with a wide range of n-type dopants and dopant concentrations. The thickness of the $��$-phase layer was most strongly correlated with the growth temperature, peaking at about 600 $^{\circ}$C. Ga interstitials are observed in $��$-phase, especially near the interface with the $��$-phase. By imaging the same region of the surface of a Sn-doped $��$-(Al$_x$Ga$_{1\text{-}x}$)$_2$O$_3$ after ex-situ heating up to 400 $^{\circ}$C, a $��$-phase region is observed to grow above the initial surface, accompanied by a decrease in Ga interstitials in the $��$-phase. This suggests that the diffusion of Ga interstitials towards the surface is likely the mechanism for growth of the surface $��$-phase, and more generally that the more-open $��$-phase may offer diffusion pathways to be a kinetically-favored and early-forming phase in the growth of Ga$_2$O$_3$.